Seeing double

As a boy in London, Oliver Sacks helped his surgeon mother do dissections at home. He later qualified as a neurologist and moved to the US. A friend of the poets Thom Gunn and WH Auden, he began to write himself, and his stories - describing the often bizarre case histories of patients suffering from brain disorders - have been acclaimed bestsellers

Oliver Sacks is merry, but without any twinkle in his serious eyes. He gives the impression of having access to some profound, bubbling joy; at the same time of sadness, touchiness, distance from the world. The same pattern that shows itself at rest comes out in the great movements of his life. In 1960, he fled his life as a newly qualified doctor in England. When he reached Canada, ostensibly on holiday, he sent his parents a one-word telegram: "Staying". He hitch-hiked to the Rockies, and then down to San Francisco, where he fell in with the poet and motorcycle enthusiast, the late Thom Gunn.

"Thom had a poem called 'The Wolf Boy', and he speaks of the duplicity of the wolf boy, between his social life and his nocturnal - that appealed to me very much, the more so as my middle name is Wolf, and so I could pretend to have a sort of lycanthropic part. I would be Dr Oliver Sacks, the intern, wearing a white coat in the daytime, and then, when the day was over, I would take off into the night, and go for long, crazy moonlit rides. But also I loved [Gunn's] combination of wild imagination with very, very strict control and perfect poetic form."

A similar clash of sober form and exuberant imagination distinguishes the most famous scene Sacks ever wrote (in The Man who Mistook his Wife for a Hat, 1985), in which one of his patients prepared to leave the office: "There was a hint of a smile on his face. He appeared to have decided that the examination was over. He started to look around for his hat. He reached out his hand, and took hold of his wife's head, tried to lift it off, to put it on. He had apparently mistaken his wife for a hat! His wife looked as if she was used to such things."

It is the last sentence which strikes the note quite unique to Sacks. Other neurologists have no doubt had patients with symptoms equally bizarre. But only Sacks can make normality appear just as arbitrary and potentially wonderful as the world in which his patients live.

Detachment, or doubleness, seems a key to his character. His books about his patients - and even about himself - are both clinical and human. Neither could be the whole truth and the account never settles into one or the other for long. Even in his relationship with America, he remains detached. Like many New York intellectuals, he talks as if Republican areas were a foreign country, but he is not even a citizen of the country he does live in.

"In 1961, I declared my intention to become a United States citizen, which may have been a genuine intention, but I never got round to it. I think it may go with a slight feeling that this was only an extended visit. I rather like the words 'resident alien'. It's how I feel. I'm a sympathetic, resident, sort of visiting alien."

He made his name with Awakenings (1973), a scarcely credible story of a disease that plunged its victims into a prison of viscous time, and a drug which catapulted them out of it, so far that they shot right through freedom and ended up compelled to unendurable impulsiveness. Although he wrote about his patients, their lives and characters, it was his own personality that saturated the story with patient, loving attention.

After the book came out, Gunn wrote him an extraordinary letter: "I got to thinking of the great diary you used to show me. I found you so talented, but so deficient in one quality, just the most important quality, call it humanity, sympathy, something like that; and, frankly, I despaired of your ever becoming a good writer, because I didn't see how one could ever be taught such a quality. Your deficiency of sympathy made for a limitation of observation.

"What I didn't know is that the growth of sympathy is something frequently delayed till one's 30s. What was deficient in those writings is now the supreme organiser of Awakenings , and wonderfully so. It is literally the organiser of your style, too, and what enables it to be so lucid, so receptive, so varied. I wonder if you know what happened. Was it simply working with the patients over so long, or the opening-up helped by acid, or really falling in love with someone, as opposed to being merely infatuated - or all three?"

Sacks reads this out, in an accent that bears no trace of his 40 years in America. There are flashes of the Oxonian drawl, which seems to have been taught to all doctors of his generation; but mostly he speaks in the precise and musical tones of Jewish North London, with every pause so distinct it could almost be transcribed into a score. "So, I was really haunted by that letter. I didn't know how to answer it. I had fallen in love, and out of love, a few times, and in a sense was in love with my patients.

"I did not think that acid, of which I had had a fair sampling, had played a real part in opening me up, although I knew it had been crucial for Thom.

"On the other hand, I wrote that I felt psychoanalysis had played a crucial role in allowing me to develop. I had been in intensive analysis since '66. But I really didn't know."

He has been seeing the same analyst twice a week for 38 years now, on Tuesdays and Fridays. Reading Sacks's books, however, suggests one of the secrets of his extraordinary sensitivity is that he is a bit of a hypochondriac. A Leg to Stand On (1984), his memoir of a crippling injury he sustained in panic flight from a bull on a Norwegian mountainside, alternates between extraordinary courage and resource in the face of real danger, and surging panic as soon as he finds himself in hospital. This would not be important except that the condition seems - perhaps uniquely - to have had an ennobling effect on his character. He treats his patients with the consideration a hypochondriac would demand for himself so he is almost preternaturally sensitive to their anxieties and triumphs. Despite the grotesque horror of the encephalitic Parkinsonism depicted in Awakenings , some of his patients with less terrible diseases, he says, would regret that theirs were so dull compared with the ones he wrote about.

One of the things that makes this empathy so remarkable is that he came from a family that seems to have been full of culture, intelligence, idealism, and even love - but to judge by his published memoirs, had no sensitivity to the children at all.

Sacks was born in London in 1933, the fourth and youngest child of two prosperous doctors, themselves the children of poor Jewish immigrants. They could have been more prosperous had they paid less attention to their patients. His father, Sam, a GP, is remembered for his devotion to the poor communities of the East End. His mother, Elsie, a surgeon, was the 16th of 18 children of Marcus Landau, shoemaker, scholar, inventor, and ritual slaughterer, who had fled Russia (and his original name of Mordechai Fredkin) to escape conscription. His father came from a much smaller family that had emigrated from Lithuania (one sister, Alida, became the mother of Abba Eban, later Israeli foreign minister).

His father, he wrote in his memoir of boyhood, Uncle Tungsten (2001), "was not given to emotion, or intimacy, at least within the context, the confines, of his family". It seems an extraordinary thing to have written: challenged about it, he says: "Oh dear!" but remembers at once the page in his hardback edition of the book where it features, and returns from the bookcase with the quotation checked: "I did say it. Consciously I was at such pains to present a sort of amiable friendly version. I said I had memories of reading with him, swimming with him, house calls with him - but not exactly talking with him."

"I think my parents were deeply sympathetic physicians to their patients, whereas I think it was more difficult for them to be parents."

His parents, he says, were not unusual for their time and class in the distance they maintained from the children they loved - apparently his own first intelligible words were, carefully enunciated, "Marion Jackson" - his nanny's name.

Both parents shared their medical passions with him. In his mother's case, this took forms that now seem grotesque: "She would occasionally bring back malformed foetuses to the house - anencephalic ones with a protruding eye at the top of their brainless, flattened heads, or spina bifida ones in which the whole spinal cord and brainstem were exposed. Some of these had been still-born; others she and the matron had quietly drowned at birth ('Like a kitten,' she once said) feeling that if they had lived no conscious or mental life would ever be possible for them. Eager that I should learn about anatomy and medicine, she dissected several herself, and then insisted, though I was only 11, that I dissect them myself."

He is puzzled that reviewers of his autobiography found this passage upsetting; or a later one, when, at 14, he is set to dissect the leg of a girl of about his own age. "Neither to me, nor to my friends, did it seem terribly eccentric. You know, mama was an enthusiast. She didn't think this might upset me, and maybe, again, I didn't reveal my upset."

None of this was ghastly, or traumatic, in the way that boarding school was. When the war came, and he was six, he was evacuated to the Midlands with his brother to a school then distinguished for its sadism as well as casual cruelty, a place from which London at the height of the blitz appeared a safe haven.

He spent four years there, furiously beaten by the masters, bullied, frozen, and half-starved. His next oldest brother, who had been 11 when he was sent there, had a psychotic breakdown after being bullied at his next school.

Boarding school cured Oliver of religious belief. As a test of God's power, he planted two rows of radishes, and prayed for God to blast one and make the other flourish. When they grew up identically, he was confirmed in his unbelief and abandonment. School, he says, affected his capacity for bonding, belief and belonging. "On the other hand, there can be too much belonging and belief - look at present-day America, with its religious fanaticism."

All the Sacks children seem to have been brilliant as well as profoundly musical. Three were doctors. One brother taught himself Arabic by the age of 16: he also learned Greek, Latin and Hebrew at school, and as an adult could speak 30 languages. Oliver went up to Oxford on a scholarship in 1951. He had wanted, as a young man, to be a chemist; his mother loved anatomy. There was a sense, he wrote, that "it was our business, the family business, to ask questions, to be 'sci entific', just as we were Jewish or English." But the medical research he did at Oxford in human nutrition was disastrous, and he did not attempt to resume a career as a researcher until after he had worked for five years as a neurologist at UCLA.

Armed with a research fellowship in neuropathology and neurochemistry at Albert Einstein College of Medicine, he came to New York City in 1966 partly, he says, because he feared the lotus-eater life of California. He wanted somewhere more dangerous and more testing. "It was my last attempt to be a real scientist. It was a disaster. So everything went wrong. I lost samples. I broke machines. Finally they said to me, 'Sacks, you're a menace. Get out. Go see patients. They matter less'."

It was a rejection that proved the making of him. Dealing with patients in this way was the first time he had really enjoyed medicine.

"I was sent in to places where it was felt I couldn't do much harm. One of them was a migraine clinic." His first book, Migraine (1970), from which he had suffered as a child, gave clear signs of his later method, though it was addressed as much to sufferers as to onlookers. It was full of quirky case histories - one patient who could only avert an attack with violent sexual intercourse; another, who arranged his entire life around the regular eruptions of the disease. In all this, his interest was not in what the illness did to the patients, but in what it came to mean to them. The kind of cure he was looking for, one felt, was not one where the symptoms merely disappeared, but where they were incorporated into the life, and almost enriched it.

It was published with the utmost difficulty. His supervisor at the migraine clinic did everything possible to obstruct him, and sacked him in the end for writing it; but the publishers Faber loved the book.

The second clinic he was sent to was Beth Abraham in the Bronx, the hospital he called Mount Carmel in Awakenings.

"When I wandered in there on my first day, I saw these frozen, transfixed people in the corridors. I had never seen anything like that. I thought: 'These are my people' - I'm sorry; that sounds rather like Moses. It came out wrong. And I would stay with them until death do us part. And I did. Most of them were older, twice my age, and yet, I think, I was a sort of parental figure."

He lives alone in Greenwich Village. "In one of my many footnotes, I referred to one of my many godchildren; but due to a printer's error, this came out in the proofs as 'grandchildren' and I was very reluctant to change this, although I thought it would cause great puzzlement - 'he finally confesses! Grandchildren ...'"

The year after Awakenings came out, in 1974, a television documentary was made in the hospital. Duncan Dallas, the producer, says: "It was in a really scuzzy part of the Bronx, and he had been left with these no-hopers; but when we made the film the patients really liked Oliver. You just had the feeling that he was a good doctor." Awakenings was made into a film in 1990.

The book had been attacked, as his later ones have been, for confusing the boundaries between literature and science. The complaint took various forms, but it all came down to the same thing: these were wonderful stories, but where were the facts? Ray Dolan, a neuroscientist in London, puts this most sharply: "Whether Dr Sacks has provided any scientific insights into the neurological conditions he has written about in his numerous books is open to question. I have always felt uncomfortable about this side of this work and especially the tendency for Dr Sacks to be an ever present dramatis persona."

At the end of The Man who Mistook the clinical diagnosis is compressed into a parenthetic phrase: "A massive tumour or degenerative process in the visual parts of his brain". Well, which was it, a neurologist might ask. But Sack's attention is so concentrated on the person that the brain damage seems almost irrelevant. He talks about the subject in a rush, starting with an example from his oldest friend: "When Jonathan Miller [director and writer] had a wonderful moment, an epiphany, or fell in love or whatever, he used to say that he wished he could have a brain print - that would completely capture his brain state at that time, so he would re-experience it and so that others perhaps could experience it. But it seems likely that the brain print of a mental state would be different in everyone, so that it couldn't be decoded by anyone else - this, among other things, might make telepathy impossible.

"Secondly, possibly because one is continually altering and reconfiguring one's own brain, it might not be intelligible. So maybe the moment and the brain state would be unique always, and one wouldn't know what to do with it, even if it could be made." Miller swears he has never used the term "brain print" and never would. "Oliver has aspects of a Borgesian fantasist. He remembers things that have never happened ..."

For most of the 20th century, it seemed science, with its impersonal descriptions of the world, and consciousness, which we experience in the first person, must be mutually exclusive terms. Science dealt in facts, and the way things are: consciousness only told us about the way things seemed to be. Even in psychology, the study of conscious experience was largely taboo. Sacks's books were one of the first and most important public demonstrations that there might be such a thing as a science of consciousness. It's a subject that suits his dualities perfectly: "I regard everything I write as being at the intersection of the first and third person, biography and autobiography, as it were."

"I think one will always need first and third person, and even if in some as yet unintelligible sense there is an equivalence, one will always have to use both languages. I'm not a real poet, like Thom [Gunn], but I have some poetry in me. I'm not a real scientist like Francis [Crick], but I have some science in me. There's enough to make both very attractive to me, and I am interesting to them."

His interest to poets is well attested. Harold Pinter wrote a play based on Awakenings, and the ageing Auden befriended him and wrote a poem, "Talking to Myself" in which he addresses his own body in terms that any Sacks patient might use: "Our marriage is a drama, but no stage-play where/what is not spoken is not thought: in our theatre/ all that I cannot syllable You will pronounce/ in acts whose raison-d'être escapes me."

Music is the place where first- and third-party accounts seem hardest to reconcile. It is possible to describe, to record, to reproduce a piece of music with absolute fidelity, but the meaning is notoriously individual and uncommunicable, except through experience. Perhaps because it is so obvious that music must be described in first and third person terms together that it is often the key that unlocks Sacks's stories. He is himself an extremely accomplished pianist, admired for it by Jonathan Miller. His perfect patient would have been the deaf Beethoven. Often he has patients - including the most famous of all, the man who mistook his wife for a hat - whose existence is rendered ordered and bearable only by music; in fact Sacks can only function by turning the details of his daily life into a kind of dance. He has often told interviewers that he likes to go to concerts with a notebook, sit at the back and write. He will not use a computer and almost all communication with his office is by fax: his archivist has catalogued 643 notebooks from all periods of his life.

Even among the deaf, he sees something like music going on: watching an old lady on her porch, he sees her fingers start to dance around each other in her lap while she gazes into the distance: she is thinking to herself, but in sign language.

The other great passion of his life is swimming, which like music, and perhaps like writing, offers a transformation into unity. "I always have my swim bag with me. I'm awful on land. I'm very conscious of stumbling and bumbling along. My brother in Australia said he could trip over an ant. I'm always stumbling into things and tripping over them, as though I don't exactly know where my body is. And that all disappears in the water, where I know exactly what I'm doing, and what others are doing. It really is a transformation, one I love, and which my father showed very strikingly. When he was in his 90s, he had awful arthritis and was more or less wheelchair bound, and we would wheel him along to a pool and sort of tip him in, where he would take off like a porpoise. He was a wonderful economical swimmer to his dying day." This sounds less like swimming in a municipal pool than Baudelaire's vision of the poet as an albatross, helpless on land, but soaring in his proper medium.

In his office Sacks is surrounded by objects productive of thought - not just books, but little desktop machines, ingots of curious elements and a fantastic poster of 1930s pop science. He breaks off conversation to press strange metals into my hands, watching delightedly as the weight of tungsten or the levity of magnesium impress themselves upon the interviewer. The world, in his presence, seems to enlarge in unexpected dimensions.

Awakenings had been a tremendous success among intellectuals. But his popular fame started with The Man who Mistook his Wife for a Hat, a collection of case studies, many originally published in literary magazines. This has been translated into 22 languages, and became a Peter Brook play. The book struck a chord with people who felt their interior lives were strange and wonderful and that here was someone who could do justice to both qualities. Sacks could understand them. It is almost impossible to read the book without feeling he is the doctor you would like to have.

Only one man gave it a really bad review, and that was Colin McGinn, a philosopher at Rutgers University, New Jersey. McGinn's professional interest in the mind/body problem runs parallel to Sacks's interest in brains and minds. McGinn is notorious among philosophers of consciousness for his pessimism, set out in such books as The Mysterious Flame (1999). He doesn't deny that there may be a scientific explanation that will unite our scientific knowledge of the brain with our experience of having minds, but there is no good reason to suppose that we can find it, he argues, and quite good ones to suppose we can't.

He had two complaints, he now says, about the book: that Sacks, in his preface, had described the stories as being "at the intersection of fact and fable", and it was unclear which bits were which; and that the style was rather luxuriant and sentimental. He also praised, and continues to praise, the effort to get inside the minds of these people, not to be "scientistic and behaviouristic". Curiously, Sacks remembers this as "the most murderous review I have ever received in my life ... he had vivisected me, skinned me alive"; but some years later he had forgotten the author; and, when he was flying to Australia, picked up a book of McGinn's for the 20-hour flight and was entranced. He wrote him a fan letter. The two met and became friends; after a few months, a shadow appeared across this friendship when Sacks realised his new friend was also the man who had wounded him so terribly.

"It was very awkward for me," says McGinn, who realised the situation first. When Sacks made the connection, his reaction was to forgive him - not without difficulty, but without stinting or drawing back. "He is the nicest person you could hope to meet," says McGinn. "At a party for his 70th birthday, my wife, who is not an intellectual, was asked to say, as we all were, some words in praise of his good qualities, and she picked out his kindness. He could never write cruelly about anyone. His intellectual originality is remarkable."

Last month, Sacks was working on essays about Gunn, Crick, and a woman who had suddenly recovered stereoscopic vision in adult life. Then he is in London this weekend to praise Sigmund Freud, at Jewish Book Week. What else would he like to do? "I liked Oaxaca city; and in particular, I thought, wouldn't it be nice to sit at the square, every day for six months, and write a novel - or something. It had a Paris-like feel in that way. I tire of my little room and my desk. I would also like to spend a life at café tables."

Books: 1970 Migraine; '73 Awakenings; '84 A Leg to Stand On; '85 The Man who Mistook his Wife for a Hat; '89 Seeing Voices: A Journey into the World of the Deaf; '95 An Anthropologist on Mars; '97 The Island of the Colorblind; 2001 Uncle Tungsten: Memories of a Chemical Boyhood; '02 Oaxaca Journal.

Some awards: Honorary fellow, American Academy of Arts and Sciences, New York Academy of Sciences, Queen's College; 2002 Lewis Thomas Prize, Rockefeller University.

· Oliver Sacks is in conversation with Ned Temko as part of the Jewish Book Week at 8.30pm, Royal National Hotel, Bedford Way, London WC1 on March 6. For tickets, call 0870 060 1798.

About this article

Profile: Oliver Sacks

This article appeared on p20 of the Guardian review section of the Guardian
on Friday 4 March 2005.
It was published on
the Guardian website
at 20.26 EST on Friday 4 March 2005.
It was last modified at 05.08 EDT on Thursday 30 April 2015.